Ladg for Early Gastric Cancer in Obese Patients

Objective: Laparoscopy-assisted distal gastrectomy (LADG) has become a popular mode of treatment for patients with gastric cancer. Less operative blood loss, less pain, early recovery of bowel activity, early restart of oral intake, and a shorter hospital stay with LADG compared with the conventional open method has been well documented. There is, however, little information on the advantages of LADG for obese patients. Conventional open gastrectomy has been reported to result in increased morbidity in obese patients. We assessed the short-term results of this procedure in a group of obese patients with early gastric cancer.

Patients and methods: We retrospectively reviewed 72 patients who had undergone LADG for early gastric cancer between March 1999 and March 2007. We compared the surgical outcomes between the non-obese, normal-BMI group (body mass index (BMI) < 25 kg/ m2) and the obese, high-BMI group (BMI > or = 25 kg/ m2). The mean BMI of all patients was 23.0; 54 patients were included in the non-obese group, and 18 patients were included in the obese group. We analyzed them in terms of operation times, blood loss, numbers of retrieved lymph nodes, and postoperative outcomes.

Results: There were no significant differences between the normal- and high-BMI groups in terms of age, sex, stage, operative blood loss, and numbers of retrieved lymph nodes. In the high-BMI group, Roux-en-Y reconstruction rather than Billroth I reconstruction was used more often than in the normal-BMI group (27.8% vs. 14.8%), due to the technical difficulties. Relatively longer operative time (359 } 66 minutes vs. 328 } 59 minutes, P=0.068) was also observed in the high-BMI group.. There was no significant difference in the postoperative courses between the two groups, as in time required to be able to walk, recovery of bowel activity, time to first solid meal, rate of complications, and the length of postoperative hospital stay.

Conclusion: In this study, LADG in obese patients was accompanied by more technical difficulties, as seen in the limited choice of reconstruction and longer operating time. Obesity, however, has little effect on postoperative courses, and we believe that LADG is likely to be beneficial for obese patients as well as non-obese patients, with early gastric cancer.

Session: Poster

Program Number: P253